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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator A o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w „� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 0 a {jl <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> m' <br /> m (DO <br /> OWNERTELEPHONE a r— <br /> Randy Holtz 612-572-0134 o F <br /> ADDRESS 4703 6th St NE Co umbia Heights MN 55421 <br /> EMERGENCY/FIRE NUMBER 21953 ROAD NAME Spirit Lake Rd ) <br /> LEGAL DESCRIPTION (see tax receiPt) G1 1 S12 T37N R18W o <br /> CONTRACTOR Donald Daniels N <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> � 47 <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 0 <br /> J <br /> N r <br /> STRUCTURE/ADDITION USE: Shower building/remodel existing block bldg. E <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> or o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). � <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building 14 <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and - <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a m <br /> c <br /> Z v <br /> PLOT PLAN 0 n <br /> M o <br /> C 1 <br /> See attached m tS1 <br /> N <br /> 0 <br /> J <br /> N <br /> O <br /> J <br /> J <br /> y <br /> N <br /> Z <br /> A� S <br /> V� <br /> i; <br /> N O C <M.W g n 2 O <br /> —K'Ga at Q m MM <br /> D m <br /> CONDITIONS OF PERMIT: < _': ,2 -$ z ro r. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o LIQ i - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =m: M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ' 6 2' ' m <br /> o : o E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my now, o : j C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- 1 a a m <br /> tioig <br /> n contained in this application(including any accompanying schedule)and I further declare that I recognize that this info C� : 8 0 8 : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a perm <br /> n it. o o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am this a <br /> providing ip- <br /> ave <br /> plication.I agree to permit county officials charged with administering county Ordinances or other authorized person to hn <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 'o x <br /> m A N <br /> 0 <br /> SIGN HERE ,.. - E I E <br /> (signatwe of owner i d' cg 0 }. <br /> ZONING ADMINISTRATOR 2.7j. C <br /> MAY 2 H� �«��HT <br /> TOWNSH P PERMITS MAY BE REQUIRED o ^n " n � $ u, m <br /> m <br /> 00 0 000 fN <br />